Health-Related Quality of Life is Prognostic of Survival in Patients With Cancer

From Medscape Medical News
Lara C. Pullen, PhD

August 30, 2010 (Shenzhen, China) — Health-related quality of life (HRQL) was found to be prognostic of survival in patients with hepatocellular and cholangiocarcinoma in a study presented here at the International Union Against Cancer (UICC)'s biennial World Cancer Congress 2010. This was true even when demographic, disease-specific, and treatment-related factors were controlled for.

More research needs to be performed to determine whether HRQL is actually a proxy for factors such as treatment adherence or sickness behavior, researchers said.

The results of this study were presented by Jennifer Steel, PhD, clinical psychologist at the University of Pittsburgh Medical Center in Pennsylvania. Dr. Steel told Medscape Medical News that "health-related quality of life may also be utilized in the design and interpretation of clinical trials testing novel treatments for cancer, not only as an end point. HRQL may be used to facilitate stratification of patients in randomized controlled trials or as a covariate when analyzing between-group differences in assessing treatment efficacy. Further research is warranted to determine if interventions improving HRQL also result in survival benefits; however, this remains a controversial area of investigation."

The study involved 321 patients who had been diagnosed with hepatocellular or bile duct carcinoma. They were administered the Functional Assessment of Cancer Therapy (FACT) Hepatobiliary instrument. Cox regression and Kaplan–Meier survival analyses were used to test the association between the 5 domains of HRQL and survival.

Overall, HRQL was found to be significantly (P = .03) associated with survival after adjustment for demographic (i.e., age, sex) and disease-specific (i.e., MELD score, tumor size, number of lesions, vascularity of lesion, vascular invasion) variables and treatment.

The physical well-being subscale of HRQL and the HepCS subscale of the HRQL were found to be significantly associated with survival (P = .02 and P = .05, respectively). The HepCS subscale measures symptoms and adverse effects.

Carolyn Gotay, PhD, professor at the School of Population and Public Health at the University of British Columbia in Vancouver, explained during an interview with Medscape Medical News that "these findings are consistent with a large body of research that indicates that the way patients evaluate their own well-being is linked to their prognosis." Dr. Gotay was not affiliated with this study.

David Cella, PhD, is the professor and chair of the Department of Medical Social Sciences at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. He was also not involved in the study, but discussed its clinical implications with Medscape Medical News. "The only downside to [quality of life] assessment is burden to the provider, which can be minimized with automated administration and scoring/reporting. Patients appreciate the concern demonstrated by asking the questions."

UICC World Cancer Congress 2010: Abstract POS-A065. Presented August 19, 2010.